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Mike PullmannEric Bruns

Ericka WigginsUniversity of Washington School of Medicine

Division of Public Behavioral Health and Justice Policywww.uwhelpingfamilies.org

Mark WirschemDajani HendersonSidney Hufstetler

King County Family Treatment CourtKing County Superior Court

15th Annual WSADCP Fall ConferenceOctober 12, 2012

The Impact of the King County Family Treatment Court on Child and Family Outcomes

A child in foster care likely has a parent with a substance problem

• 80% of children in foster care have a parent with a substance abuse problem– Parents with substance problems have the

lowest rate of reunification with their children– Their children stay in foster care over twice as

long on average

• Initiation of treatment takes an average of 4-6 months after entry to CW system

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Family Treatment Courts are a rapidly prolifierating type of Drug Court

• FTDCs apply the drug court approach to cases of child abuse and neglect

• Goal = enhance possibility of family reunification within legal timeframes by:– Facilitating entry and completion of treatment– Supporting parent to remain abstinent– Improving child safety/family functioning

• As of 2009, NADCP reports 322 FTDCs– 13% of all drug courts in U.S.– Increase of 66% from 2005

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14 counties with FTDCs in Washington

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Today’s presentation

• The King County Family Treatment Court– Goals– Population of focus– Program description– Case flow process

• What we have learned from an outcome evaluation

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The King County Family Treatment Court

Mark Wirschem, Juvenile Court Services Manager

Dajani Henderson, FTC Court Specialist

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KCTV Video

• http://youtu.be/XU1gSDyTBxw

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The KCFTC has four Goals:

• Children have safe and permanent homes within permanency planning guidelines;

• Families of color have outcomes from dependency cases similar to families not of color;

• Parents are better able to care for themselves and their children and seek resources to do so; and

• The cost to society of dependency cases involving substances is reduced.

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KCFTC PROCESSES AND FUNCTIONS•Comprehensive SB Assessment•High quality, appropriate CD Services•Timely/effective MH and other services•Effective care planning and management•Expanded and more frequent visitation•Consistent, timely incentives & sanctions•Random UA Screens•Effective pre-hearing case conferences•Effective judicial interaction

SHORT-TERM OUTCOMES•Eligibility/enrollment completed quickly•Enrollment in appropriate CD services•Parents compliant with/complete treatment•Parents ultimately able to remain sober•Parents/children more fully engaged in svcs•Parents/children receive needed services•Decreased placement disruptions•Parents compliant with court orders•Less negative effect on child well-being•Less disruption of child-parent bonds•Increased family reunification rates•Earlier determination. of alternate placement options

NATIONAL BEST PRACTICES•Communication bw Court and providers•Judge plays active role in Tx process•Judge responds to positive & noncompliant beh.•Mechanisms for shared decision making•Accountability for Tx services•Strategy for responding to noncompliance•MIS allow data to be assembled/reviewed•Enhancement of due process•Team members provided adeq resources

The King County Family Treatment Court

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Population Focus

Up to 60 children at a time, whose parent(s):• Admit to the court that his/her child is dependent or have

an existing dependency finding• Are chemically dependent and willing to go to treatment;• Are at least 18 years of age;• Sign a Consent to Release Confidential Information

Form so that the team may share information with other team members and outside community providers;

• Have no felony child abuse or sexual abuse guilty findings; and

• Applications/referrals to FTC must be received no later than six months from the date of dependency petition.

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KCFTC Program Model• Parents agree to enter a more intensive court process

– Expectation = 12 mos – 2 years duration• Case management to ensure connection to appropriate

chemical dependency treatment• Social Workers dedicated to the FTC with reduced

caseloads (12:1) and a Court-Appointed Special Advocate is dedicated to each KCFTC family

• Formal Wraparound Process for approx 1/3 of families (15 at a time)

• Treatment Liaison who monitors parent’s progress in CD and MH treatment and provides case management

• Case review hearings every other week until frequency can be stepped down

• Cross-disciplinary pre-hearing staffings to present a unified approach at hearings

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KCFTC Team Members

• Judge• Assistant Attorney

General• Parent’s Defense

Attorney• Child’s Attorney• Treatment Specialist• Treatment provider

• Court Appointed Special Advocate (CASA)

• Wraparound coordinator• DCFS Social Workers• FTC Program Supervisor• FTC Program Court

Specialist• Family members/friends• Family support providers

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Placement in Shelter Care

Dependency Petition Filed

Shelter Care Hearing(w/in 72 hours of place-ment or filing, whichever

occurs first)

Pre-TrialConference(21 days prior to

fact-finding)

Fact-Finding Hearing

(w/in 75 daysof filing)

Disposition Hearing

(same day as or w/in 14 days of dep finding)

Review Hearing(the sooner of 90 days from Dispo. or 6 mos.

from date of placement)

Permanency Planning Hearing(12 months from date of placement & every 12

months thereafter)

Review Hearing(w/in 6 months after

permanency planning hearing)

PetitionApproved

DependencyContinued

Exit System

Yes

PermanencyGoal Achieved?

Yes

PermanencyGoal Achieved?

Petition forParental Rights Termination?

No

No

Petition forParental Rights Termination?

No

No

Petition for Termination of Parental Rights

Filed

Yes

Yes

PetitionDismissed

PetitionDismissed

PetitionDismissed

PetitionDismissed

30-Day Shelter Care Review(w/in 30 days of

placement)

Shelter Care Case Conf.(30 days prior to

fact-finding)

PetitionDismissed

Dept. supervision

continues for 6 mos.

Childreturned

home

Review Hearing

PetitionDismissed

Dependency Stipulated

Enter FTC*(See separate

flow chart)

Enter FTC*(See separate

flow chart)

Exit FTC w/o Permanency Goal Achieved

Exit FTC w/o Permanency Goal Achieved

Original Chart prepared by Michael Curtis on January 12,

2006

*There can be entry into FTC anytime after dependency is established as long as a referral is made to FTC within 6 months of the filed petition date.

*There can be entry into FTC anytime after dependency is established as long as a referral is made to FTC within 6 months of the filed petition date.

Juvenile Dependency Case Flow (noting FTC)

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FAMILY TREATMENT COURT CASE PROCESSING FLOW CHART

Check In Hearing: Set for following week after positive/missed UA or noncompliance w/ tx

Compliance Clock Hearing: Can be applied

after 5th response and set 60 days out from

current hearing

Motion Hearing: Can be set anytime there is a contested issue. Not

heard during regular FTC calendar

Discharge/Opt Out Hearing: Dependency

dismissed or discharged

to regular dependency

Other FTC Hearings:

Box Color Legend:

Red: Not a hearing

Green: Beginning and end of FTC Process

Blue: FTC Review Hearings

Graduated Blue: Does not occur on every case

Orange: Not unique to FTC

Purple: Unique to FTC and can occur throughout FTC process

Sidney Hufstetler

King County Family Treatment Court Graduate

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Evaluation of the King County Family Treatment Court

Division of Public Behavioral Health and Justice Policy

University of Washington School of Medicine

UWHelpingFamilies.org

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Goals for the Current Evaluation

• Provide information needed by the KCFTC and its stakeholders

• Expand the research base on FTDCs– Do FTDCs achieve their stated goals and outcomes?– Do they contribute positively to federal priorities for

CW systems?– Do common criticisms of drug courts apply to FTDCs?

• Widening the net of involvement in justice system• Mandate longer involvement in justice system• Limit access to or completion of treatments• Not cost effective

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Components of the KCFTC Evaluation

• Process evaluation– Interviews with team members and

stakeholders, 2006 and 2008– Parent interviews, 2007-2009

• Outcomes evaluation– Analysis of child placement data from Children’s

Administration and adult treatment data from the Division of Behavioral Health and Recovery

• Cost-benefit analysis– Currently underway

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Outcome Evaluation:Research Question 1

• When compared to comparable non-FTDC participants, do FTDC participants differ in terms of their experience with the court and treatment system?

• Hypotheses – FTDC participants would:– Have more court hearings; – Enter treatment more often;– Enter treatment more quickly;– Attend treatment sessions more consistently;– Receive more treatment events;– Receive a broader treatment array;– Remain in treatment longer; and– Successfully discharge from treatment more often.

Research Question 2

• When compared to children of non-FTDC participants, do children of FTDC participants demonstrate more positive child welfare outcomes?

• Hypotheses – KCFTC children would:– Spend less time in out-of-home placements;– Reunify with their parents more often;– Get placed in permanent living situations more quickly;

and– Have fewer subsequent child welfare investigations and

founded investigations20

Research Question 3

• Do families of color have outcomes similar to families not of color?– Treatment outcomes– Child welfare outcomes

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Outcome Evaluation• Administrative data:

– Treatment data from Division of Behavioral Health and Recovery – Child welfare data from Children’s Administration– Hearing data from King County Superior Court– Data collected September 2010

• Family Treatment Court group:– Selected all parents admitted to the FTC between March 2006

and October 2009

• Comparison group:– Eligible parents referred but not admitted to the Family

Treatment Court– Randomly selected a reasonable number– Statistically matched (propensity score methods) on caregiver

age and race, number of prior child welfare investigations, whether parent was in treatment at petition, number of prior treatment episodes, and primary drug of choice

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Reasons why parent is in comparison group

Percent

Attorney not responding 42%

Over 6 months without referral 18%

Chose not to participate 8%

No known address/can’t locate/on run 7%

Other 8%

Reason missing 17%

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44%

1%

6%

1%3%

1%

7%

1%

14%

23%

56%

15%

40%

59%

18%

Parentwhite

Parent ofcolor

AfricanAmerican

AmericanIndian

Asian Hispanic PacificIslander

Missing

Comparison

FTC

Parent mean age• Comparison = 31• KCFTC = 31

Mean # of children per participant• Comparison=1.39• KCFTC = 1.46

Detail: specific race/ethnicity

Total # of parents = 268• Comparison = 182• KCFTC = 76

Parent demographics

Note: no significant differences

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Prior Investigations

Comparison %or Mean (SD)

KCFTC %or Mean (SD)

Any investigation completed prior to petition 83% 79%

Type of Allegation (index petition)

Neglect 83% 77%

Abuse 36% 36%

Prenatal Injury 8% 9%

Medical Neglect 8% 7%

Abandonment 2% 3%

Number of investigations prior to petition 2.1 (2.1) 1.8 (2.3)

Note: No statistically significant differences

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50%

4%

10%

2%

26%

6%

1%

17%

50%

35%32%

38%

54%

46%

28%

Female Male White AfricanAmerican

Asian/PI NativeAmerican

Hispanic Unknown

Comparison

FTC

Child Mean Age• Comparison = 4.2• KCFTC = 3.5

Number of children• Comparison = 235• KCFTC = 89

Child demographics

Note: Statistically significant difference for Native American

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Status of FTC parent at time of data collection

FTC(n=76)

Discharged 33%

Graduated 26%

Currently enrolled 22%

Opted out of program 11%

Certificate of participation 7%

Dismissed 1%

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Note on Analytic Approach…• 1). “Intent to treat”

– All parents who were admitted to FTC were included in all analyses, even if they opted out or had an unsuccessful outcome.

• No parent who was ever in FTC was ever included in the comparison group

• 2). Index Petition Date– “Time Zero” or comparable start point for both groups

was the petition date, not date of entry into FTC (comparison group had no date of entry)

These decisions likely result in more conservative findings

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• Question 1: Do FTC participants have different treatment and court experiences than comparable non-FTC parents?– Do they experience more court hearings?– Are they more likely to enter treatment?– Do they enter treatment more quickly?– Are they more likely to attend treatment?– Do they remain in treatment longer?– Are they more likely to be successfully

discharged from treatment?

FTC parents have more court hearings

• 11 months post petition (min follow up time for overall sample):– FTC: mean 16.1 (SD = 4.8) hearings– Comp: 5.9 (2.4)

– (p<.001)

• Review hearings were 4.5 times more frequent for FTC (accounted for 75% of all FTC hearings)

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FTC parents are more likely to enter treatment

40%

20%

53% 52%59%

32%

88%84%

Admittedprior topetition

In treatmentat petition

Admittedafter

petition

Received txafter

petition

Comparison

FTC

Note: All differences statistically significant

FTC parents were 63% more likely to be admitted to treatment.

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FTC parents enter treatment three times as fast

Of those parents entering treatment who were not already in treatment at the index petition, the median days until treatment entry were:

• Comparison: 120

• KCFTC: 36

Note: Statistically significant difference, p < .001

Pro

por

tion

not

adm

itted

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FTC parents received broader service array

Of those admitted to any treatment

Comparison(n=52)

KCFTC(n=68)

Long term Residential* 46% 65%

Intensive Outpatient 40% 56%

Outpatient 50% 50%

Intensive Inpatient 44% 35%

Methadone 23% 27%

Recovery House* 2% 9%

Housing Support 8% 3%

* Statistically significant difference, p < .05

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FTC parents received broader service array

Of those who received any treatment

Comparison(n=44)

KCFTC(n=64)

Individual therapy* 89% 100%

Group therapy 90% 97%

Case management 81% 89%

Urinalysis 43% 52%

Methadone/opiate subst. 15% 25%

Childcare* 11% 25%

* Statistically significant difference, p < .05

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FTC parents received more treatment but were not

significantly more likely to attend treatment

Comparisonn=6,188

FTCn=8,357

Attended treatment episode 88% 90%

Excused by provider 6% 4%

No show, unexcused 8% 6%

Note: Statistically significant difference, p < .05

Avg. # of treatment events per person who received treatment:

• KCFTC = 116 (SD=97)

• Comparison = 51 (SD=57)

Note: Not statistically significant difference, p =.40

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FTC parents remain in treatment longer

(Of those entering treatment; N=110)

Of those parents who entered treatment, the median days in treatment were:

• Comparison: 44

• FTC: 109

Note: Statistically significant difference at beginning and

middle, p < .05

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FTC parents more likely to be successful in treatment

• FTC parents remained in treatment twice as long (median of 109 days compared to 44)

• FTC parents 37% more likely to be successfully discharged from treatment (72% compared to 54%)

Note: Statistically significant differences, p < .05

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• Question 2: Do FTC families, compared to similar families who did not receive FTC services, have more positive child welfare outcomes? Specifically:– Do the children of FTC participants spend less time in

out of home placement?– Are the children of FTC participants placed in

permanent living situations more quickly overall?– Are FTC children more likely to have a permanent

placement?– Are FTC participants less likely to have subsequent

CPS investigations?

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FTC children spend less time in out-of-home placements

Note: Statistically significant difference, p < .05

Median days in out of home placement:

• Comparison: 689

• FTC: 476

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FTC children end involvement with the child welfare system more quickly

Note: Statistically significant difference, p < .05

Median days until permanent placement:

• Comparison: 813

• FTC: 718

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Child Welfare OutcomesAt end of study window

• FTC children spent 30% less time in out-of-home placements– median of 476 days, compared to 689

• FTC children spent 20% less time in the child welfare system– median of 718 days, compared to 813

• FTC children 43% more likely to have a permanent placement– 61% compared to 43%

Note: Statistically significant differences, p < .05

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Placement types/ReunificationAt end of study window

• FTC children 2.5 times more likely to return to the custody of their parent (27% compared to 11%)

• FTC children half as likely to be in an out of home placement (24% compared to 46%)

• FTC children 1.9 times more likely to be returned home (in parental custody, reunified, trial home visit; 55% compared to 29%)

Note: Statistically significant differences, p < .05

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Subsequent child welfare investigations: All parents

At end of study window

Note: Not statistically significant difference

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Subsequent child welfare investigations: Only parents with child returned home

At end of study window

p=.09 p=.13

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Subsequent child welfare investigations: All children

At end of study window

Note: Not statistically significant difference

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Subsequent child welfare investigations: Only children who returned home

At end of study window

Subsequent removals: 3% for FTC group (n=1) vs. 13% for Comparison (n=3); p=.13

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Question 3: Do families of color have outcomes similar to families

not of color?

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Comparing FTC to regular court for families of color

• Generally indicate that families of color in FTC had more positive outcomes than families of color in the comparison group– 61% more likely to enter treatment– Enter treatment 63% faster– Remain in treatment nearly twice as long– 49% more likely to complete treatment– Children 39% more likely to be permanently placed– Children 54% more likely to be returned home

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Comparisons by race in FTC

• Parents of color in the FTC were not significantly different than white parents on:– Percentage admitted to treatment– Speed of admission to treatment– Percentage successfully completing treatment

• Parents of color spent less time than white parents in treatment

• Children of color might be more likely to remain in out-of-home placements (borderline significance)

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Outcome Study Summary• The King County Family Treatment Court is one of a

variety of problem-solving courts• Staff from several disciplines and agencies collaborate

on supervision and support• Stakeholders generally have positive opinions about the

development and functioning of the court• Parents have more successful substance use treatment

outcomes• Children are more likely to exit the child welfare system

and be returned to the care of their parents• Other research with similar findings to our research also

found significant long-term cost savings

Internal vs. External costs and benefits

Overall costs/benefits to society

County government

State government

Federal government

Participants

Child Welfare DSHS (treatment)

Citizens and communities

Family Treatment

Court

• External benefits underproduction of the service (i.e. too little Family Treatment Court)

• External costs overproduction of the service

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Child Welfare

Placements

Caseworker time

Caregiver-child visitations

Substance Use and Mental Health treatment

DSHS-provided treatment services

Private pay or insurance treatment services

Justice System

Dependency court hearings

Adult contacts with law: prison, jail, criminal hearings, probation, etc.

Child contacts with law: prison, jail, criminal hearings, probation, etc.

Damages to victims

Non-monetary costs

Emotional pain from loss of child/parent

Broken communities

Emotional pain to victims

Others

Employment

Education

Physical health care

Public assistance

Costs and Benefits

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The FTDC Literature to date is small in scale but largely positive

• Five peer-reviewed studies of FTC model (Boles et al., 2007; Burrus et al., 2011, Edwards et al., 2005; Green et al., 2007, 2009; Worcel et al., 2008)

• All studies show positive outcomes:– Parents enrolled in treatment more quickly– Parents received treatment services for a longer mean duration (3 of 4

studies)– Parents were more likely to successfully complete treatment– Children placed in permanent living situations more quickly (3 of 4

studies)– Children more likely to be reunified (e.g., 42% vs. 27% at 2 years; 70%

vs. 45% at 3-4 years)• No study found between-group differences in future abuse/neglect reports

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Some evidence that FTDCs provide an overall return on investment

• NPC Research, the most active evaluators of FTCs and drug treatment courts, has completed several cost-benefit analyses at sites across the nation.Location Cost savings

per participantReturn on

investmentAreas of savings

Harford Co., MD

$12,000 over 1 year

350% Foster care days, Criminal justice, Court Cases

Jackson Co., OR

$5,593 over 4 years

106% Foster care days, Probation/Parole, Court Cases

CA "Court 1" $1,657 over 4 years

130% Not provided

CA "Court 2" $2,141 over 5 years

Not provided

Not provided

Baltimore, MD

$5,022 over 1 year

Not provided

Foster care days (did not examine other areas)

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Please contact us with any questions

Eric Brunsebruns.@uw.eduMike Pullmann

pullmann@uw.edu

Mark WirschemMark.Wirschem@kingcounty.com

Dajani HendersonDajani.Henderson@kingcounty.gov

Jill MurphyJill.Murphy@kingcounty.gov

FTC Program Websitehttp://www.kingcounty.gov/courts/JuvenileCourt/famtreat.aspx